National survey of critical care nurses' perceptions of end-of-life care and effect of incentives on survey response rates

Critical-care nurses care for dying patients daily. The process of dying in an intensive care unit (ICU) is complicated. Research with regard to obstacles and helpful behaviors that impede or support critical care nurse delivery of end-of-life care is limited. This study advances work completed in the pilot study. The primary aim was to measure critical-care nurses' perceptions of obstacle severity and frequency and the intensity and frequency of helpful behaviors in providing end-of-life care. A secondary aim was to compare the effect of three different incentives on critical-care nurses' survey response rates using a theory on immediacy. An experimental, posttest-only, control group design was used. A random sample of the American Association of Critical-Care Nurses (AACN) yielded 861 usable responses from 1,409 eligible respondents (61%). The three most severe obstacles were frequent calls to the nurse, families not understanding the term ;lifesaving measures" and physicians disagreeing about the direction of patient care. The three most intense helps were when nurses allowed the family adequate time alone (after death), provided a peaceful and dignified bedside scene, and taught the family how to act around the dying patient. Other results included nurses preferring that a patient experience a "good death" more time be provided to care for patients, communication to patients be more open and honest, and education in end-of-life care be provided to physicians and nurses. Nurses reporting more ICU work experience were older and also had cared for more dying patients (75%) than did nurses reporting less experience (62). Certified critical-care registered nurses (CCRNs) perceive as larger obstacles physicians being overly optimistic about the patient surviving, families not accepting that the patient will die, visiting hours that are too restrictive, and patients who have pain that is difficult to alleviate or control. For the secondary aim, the $2 incentive was the only one found to be associated with significantly improving response rates. Although overall response rates were less than planned, the theory of immediacy did help explain the outcome of the response rates.